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Mastectomy
What to Expect

Contents
 
Some Reconstruction Options
 
And.. No Reconstruction
 
What to Expect Post-Op

Personal Accounts & Advice

Medical Instructions
 
Photos
  A personal account and photos from Pat Murray

Videos

Discovery Channel's video of the operation
 

Some Reconstruction Options


Your surgeon will have lots more info for you, but there are a number of options.

There is implant, like silicon or saline, which allows more size, but involves "unnatural" materials, and can also involve long periods of stretching.

There are "flaps", where tissue from the tummy or the back can be stretched up onto the breast, tunnelling from under the skin.  Sometimes tummy flaps can cause some weakness in the tummy, and sometimes need a mesh reinforcement.  The flap from the back can be a little painful for awhile, since the nerves & blood vessels have to stretch so far.  And the doing a flap usually means the new breast can't be so big, sometimes requiring a reduction of the other breast.

If you have a flap, and sometimes if you have an implant, you will probably also have a fake nipple grafted on.  There are a variety of ways of doing this.  Sometimes they take a tiny amount of tissue from the groin, in which case the color is pretty natural.  If they take it from uncolored skin, then you might also have a tattoo, somewhat later, to darken the fake nipple so it matches the real one.

There's also the option of leaving it alone, and wearing a filler in the bra, or not.

Main thing, let your surgeon know that you are interested in looking at all the options, rather than getting spoon-fed with a particular one.  I'm sure she/he will be happy to discuss the different pros and cons with you.

 

And No Reconstruction


From Harriet, July 27, 1997

If you're leaning toward no reconstruction, here are some more things you might want to read in that direction:

I started thinking about refusing reconstruction when I read a journal on the Web (which I found at www.breastcancer.net, under "personal survivor's Web pages") by Nancy Oster. It is at

http://www.silcom.com/~noster/choice.html

Both my internist and my surgeon strongly recommended reconstruction, and I have deep respect for both of these doctors. The excellent plastic surgeon with whom I met made it clear, however, that he couldn't promise me a pain-free result, especially with my scoliosis (a curvature of the spine).

When I first made the decision, I expected that I would use a prosthesis, and I dreaded having to wear a bra. I thought I might use a prosthesis that attaches with tape and velcro. It turns out that my other breast is so small that even the smallest ready-made prostheses don't match, and that I am perfectly comfortable going bra-less and not worrying about it. But my breasts have never been important to my sense of my own appearance (perhaps because I am so flat-chested), so I wasn't giving up much, in terms of self-image. Also, I have a loving, supportive husband who wasn't troubled by this loss [though we joked that if he WERE troubled by it, it would make more sense to get him therapy rather than getting me a reconstruction]. Losing my hair might be more difficult (but that will be temporary).

Since I made the decision, there have been additional developments that made me even more happy about my decision. Even though 8 doctors had examined me and predicted that I had no lymph node involvement, it turned out that I had eleven positive lymph nodes. That means I need a very aggressive course of treatment, including high dose chemotherapy and "stem cell rescue," regular chemotherapy, and radiation. I had a port-a-cath installed, which was painful for the first week. With all this going on, I am VERY glad that I am not also dealing with more difficult recovery or with ongoing pain from complications of reconstruction.

Having said all that, I fully believe that reconstruction IS very important for many women, in terms of self-image and peace of mind. Whatever makes you feel good about yourself probably improves your immune system. So you have to decide what is best for you. Both my internist and my surgeon are very conservative, and both of them thought reconstruction at the time of the initial surgery was a very sensible choice.

 

What to Expect Post-Mastectomy


As our friends have faced mastectomy, one of the things they've wondered is what to expect post-op -- what are the limitations, how soon can they get back to normal activities.  Here are some personal accounts, followed by the text from the instructions given to me by my doctor when I had mine.

Alexandra Koffman, February 23, 1997

I have read some messages on the internet- where the tram failed, I concluded that the main failure was the patient were smoking ( smoking constricts vessels). &nsbp;So if you smoke, I would give it up. Also, if you are comfortable with your MDS, that's more important then a second opinion. ...I went to Brigham and Women's and had a great experience.

I was told NOT to wear a bra for 4-6 weeks, find out from your MD what his/her preference is so you can prepare (I bought some soft undershirts to keep my clothes from rubbing).

I also rearranged my bedroom so it would be easier to get in and out of bed.  I also got a body pillow for the bed, so I could prop myself eating, and as a barrier from my husband rolling over towards me.

Actually the pain from the whole experience this far for me has been less than some toothaches I had.

   Alex


Adena Hostetler, February 24, 1997

>>How long are the drains in? Have you found one type clothing that works best while recovering..ie button up, or slip on, etc?<<

Glad that you asked about clothing... I remembered last night that I should have said something. You will probably find that clothing that is loose and oversize works best initially. (Oversize t-shirts, sweatshirts, and big shirts that button down the front). Since, you'll be wearing this elastic thing around your middle, stick to elastic waistbands. For a while there is some swelling in the abdomen and loose clothes are most comfortable.

I think that my masectomy drains were in for around 10 days. Two drains for my TRAM were taken out after five days and the other two remained for another week.

Follow your doctors instructions about not lifting more than 5 lbs., etc. Also do the exercises that you are given to recover movement after the masectomy. It's uncomfortable in the beginning, but well worth it later on. I found it helped to keep my arm elevated (masectomy side). You may be contacted by a Reach to Recovery volunteer. Very helpful program - the volunteers are all breast cancer survivors and I appreciated the tips that they gave to me.

Again, please know that you're not alone. Thoughts and prayers are with you.

Hugs,
   Adena


Lehua Wells, June 14, 1997

I think doctors vary in their instructions. My doc told me two weeks before I could drive. I cheated, of course. Driving was perfectly okay when nothing unusual happened, but when someone cut in front of me and I had to jerk the wheel, it hurt like hell. Beyond words. It was also horribly painful to pull the brake up after parking. It also hurt very much to pump gas. Opening my car door was painful, also opening my trunk.

I was able to brush my teeth, comb my hair, change my drains, and shower. Getting dressed was hard for about 4-5 days.

Chores, it depends on what. I could eat bread, cookies, popcorn, fruit, etc. But lifting the large frying pan was impossible, as was opening some of my jars. Opening cans was out of the question. Scooping icecream was impossible. I tried to make coffee, but lifting the coffee pot after I'd filled it was hurtful. I couldn't use anything on high shelves because of stretching. It hurt to open jars with tight lids. I couldn't sweep or vacuum (vacuum too heavy to move). I missed some of my medications because they were in child-proof containers, where you have to press hard downwards, and I couldn't open them. I could water my floor plants using a small cup, but couldn't water my hanging plants up high. Feeding my cats was very hard because of the large bags, I had to scoop the food out with a cup because I couldn't lift the bags.

I'm sure there are lots more things that I forgot.

Here's my take, NOT NOT NOT as a doctor, but just personally, as a patient:

It's very difficult and painful, and potentially recovery-threatening to be completely alone the first 4-5 days. After that, it's do-able to be alone, but there are lots of miscellaneous small hardships, and things that one has to do without. After two weeks, although there was still some pain and some difficulty, I could pretty much manage anything I really needed.

I would say, under no circumstances, to drive for the first week, in case of needing to swerve or refill gas, etc.

And I think it's really important to respect the doc's instructions, since she/he's the one who has to take the heat if something goes wrong.

I wore a very soft sports bra after all of my lumpectomies, and it helped. After the mastectomy I would not have worn one, except that I also had a reduction at the same time, and I wore it for the sake of the reduced breast. "Jiggle-and-bounce" are very painful after surgery, and the main reason for the sports bra was to stop any movement from happening. Even after the pain stopped, there was oozing/draining, so I got cheap men's t-shirts and wore them all the time in lieu of a bra, to keep my clothes from getting damaged. I'm still having some pain from all the stuff that's been going on, and a pillow helps for sleeping. I started that after the first lumpectomy, and kept on. I had a feather pillow that was beaten down into being small and soft. I replaced it with a new one for normal purposes, and kept the old one for my chest. I hug it to my chest whichever side I'm sleeping on, and it keeps my arm from weighing on my breasts, and buffers the pressure against the mattress.

Even with small breasts, like after my mastectomy/reduction, movement still hurts, so support was still important.

Hope this helps...
Regards,
   Lehua


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Medical Instructions

Here are the activity & bathing instructions I was given by my doctor for my mastectomy:


  1. Activity:  Spend the next few days resting
     
    • Avoid any strenuous lifting (greater than 5 lbs.), pulling or pushing or raising arms above shoulder/head level for the next 2 weeks.
       
    • Refrain from all strenuous activities including bending forward, climbing stairs, straining and having sex for 2 weeks.
       
    • No athletic activity or vigorous exercising (jogging, swimming, aerobics, etc.) for 3 weeks.
       
    • Walking and gentle movement of the arms are encouraged.
       
    • No driving for 5 days.  Wear seatbelts to avoid an accidental impact to the chest in case of a sudden stop.
       
  2. Baths:  You may shower after your dressings are removed and as instructed by your doctor.  Avoid hot temperatures/water to breasts.

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Photos from Pat Murray

Pat Murray had a mastectomy and reconstruction, and has given us the gift of not just a personal account, but some pictures on the 'net. If you want to know what this was like for Pat, visit her at http://web.mit.edu/afs/athena/user/p/a/pamurray/www/artbc.html.

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Videos

Alexandra Koffman let us know that Discovery Channel has a video of the breast reconstruction operation. Order as follows:

Discovery Channel
The Operation: Breast Reconstruction
Phone 800-813-7409
Item #24829, cost between $20-25

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